Privacy, respect for dignity, and confidentiality are central components of good patient care. In the speciality of Obstetrics and Gynaecology, clinical situations of a sensitive nature occur and women may present with unexpected pregnancy loss or receive other bad news about their pregnancy. While we cannot change this, we can make the circumstances worse. The typical surrounding environment and lack of privacy in many clinical areas can compound distress.
The Emergency Room (ER) at Cork University Maternity Hospital (CUMH) is a busy 24-hour facility, and over 17,000 women are seen there annually. We were aware that privacy and confidentiality in the ER were compromised by its physical design. Individual cubicles’ curtains and spacing of trolley gave some visual and auditory discretion, but in reality curtains afforded little privacy.
Following recent renovations, we conducted a study to explore if refurbishments improved the patient experience in our ER. We prepared a survey asking specific questions about women’s perception of privacy and confidentiality. We then repeated the survey following renovations, after which the size of the ER remained the same but curtained spaces were replaced by individual walled cubicles with secure sliding doors. To date, over 120 women have completed the surveys; the majority (84%) were pregnant.
Women commented on what they saw or heard during their visit to the ER; before and after the renovation works:
“I could hear a pregnant woman in labour in a lot of pain right beside me.” [before]
“I was examined behind curtains and men and other patients . . . could see me and it made me very uncomfortable” [before]
“I could see blood on the ground in the cubicle beside me.” [before]
“I was a patient before with the curtains and I could hear all conversations in the room. The new set-up is 100 times better.” [after]
“Everything about the ER was private and the staff were amazing and professional.” [after]
Before the renovations, 49 per cent of women reported overhearing a conversation about themselves during their ER visit. After the walls were put up, this dropped to just 9 per cent. Before the renovation, more than 50 per cent also overheard a conversation about another woman while in a cubicle, with this also dropping to 9 per cent afterwards. Conversations were overheard at the nurses’ station, in the cubicle alongside, and extended to hearing staff on the phone talking about personal medical details. Only one-in-five women found their privacy to be adequate during their visit to the ER before the refurbishments, with this rising to 83% afterwards.
Parents who receive the news that they have lost their baby are particularly vulnerable, and the physical space that surrounds this experience is hugely relevant. How pregnancy loss is managed in a hospital setting has a direct and lasting influence on parents’ ability to cope at that time and recover from the experience. Our study indicates that the refurbishment of our ER has significantly improved privacy and confidentiality for the women attending. We recommend that other Obstetric units consider walled rooms instead of curtained cubicles when renovating or designing new ER departments.
For more information:
§ The Pregnancy Research Loss Group at University College Cork, Cork University Maternity Hospital, Cork, Ireland.
§ Email Dr Keelin O’Donoghue.
More articles from Ireland in this series are available on the EAPC Blog . . .
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